A new study found that nearly 20 percent of eligible adults in Medicaid expansion states are in danger of not meeting the minimum work hours that will be required nationwide beginning January 1. Women, unmarried people, White individuals, and those with limited education all had a higher risk of losing their health coverage due to noncompliance with these new requirements.
“Republicans have made staying on Medicaid significantly harder by passing the 2025 budget reconciliation package (often referred to as the “One Big Beautiful Bill” or “Big Ugly Bill”), which President Donald Trump signed into law.The Republican-backed legislation implements strict new administrative and eligibility mandates aimed at cutting federal spending and reducing fraud.
Critics and independent analyses warn these policies rely heavily on “death by a thousand cuts” bureaucratic barriers that risk kicking millions of eligible Americans off their health insurance due to paperwork confusion.The primary changes making it harder to maintain coverage include:
The Impact: Enrollees must routinely submit reporting paperwork to prove compliance or a narrow exemption (such as being “medically frail”). If they fail to navigate the reporting system, they lose coverage.Timeline: While the federal mandate officially takes broad effect on January 1, 2027, states were permitted to opt-in early. For example, Nebraska began removing enrollees for work requirement non-compliance in August 2026.
The Impact: Doubling the frequency of recertification multiplies the risk of “procedural denials”—where families lose coverage simply because a state notice was sent to an old address, or because they couldn’t manage the influx of state paperwork in time.
The Impact: Health organizations note that even individuals with complex illnesses like cancer now face tighter administrative burdens to gather medical records to prove they are too sick to work.Projected OutcomesThe Congressional Budget Office (CBO) estimates these cumulative changes will strip health insurance from roughly 6 million Americans over the next decade, reducing federal Medicaid spending by hundreds of billions of dollars.
Research from groups like the KFF indicates that because the vast majority of working-age Medicaid recipients are already employed or have valid caregiving/health limitations, the vast majority of those who lose insurance will do so because they are unable to manage the complex new paperwork.”